Chaugai Sandip, Sherpa Lhamo Yanchang, Sepehry Amir A, Arima Hisatomi, Wang Dao Wen
aDepartment of Internal Medicine and Institute of Hypertension, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China bDepartment of Community Medicine, Section of Preventive Medicine and Epidemiology, University of Oslo, Oslo, Norway cUniversity of British Columbia, Division of Neurology, Vancouver, Canada dThe George Institute for Global Health, Royal Prince Alfred Hospital, Sydney, NSW, Australia eDepartment of Medicine, Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, TN.
Medicine (Baltimore). 2016 Jun;95(26):e4059. doi: 10.1097/MD.0000000000004059.
Recent studies have demonstrated that atrial fibrillation significantly increases the risk of adverse clinical outcomes in high cardiovascular disease risk subjects. Application of renin-angiotensin-aldosterone system blockers for prevention of recurrence of atrial fibrillation and adverse clinical outcomes in subjects with atrial fibrillation is a theoretically appealing concept. However, results of clinical trials evaluating the effect of renin-angiotensin-aldosterone blockers on adverse clinical outcomes in high cardiovascular disease risk subjects with atrial fibrillation remain inconclusive.A pooled study of 6 randomized controlled trials assessing the efficacy of renin-angiotensin-aldosterone blockers on subjects with atrial fibrillation was performed.A total of 6 randomized controlled trials enrolled a total of 53,510 patients followed for 1 to 5 years. RAAS blockade therapy was associated with 14% reduction in the incidence of heart failure (OR: 0.86, [95%CI: 0.76- 0.97], P=0.018) and 17% reduction in the incidence of CVE (OR: 0.83, [95%CI: 0.70-0.99], P = 0.038). The corresponding decline in absolute risk against heart failure (ARR: 1.4%, [95%CI: 0.2-2.6%], P = 0.018) and CVE (ARR: 3.5%, [95%CI: 0.0-6.9%], P = 0.045) in the AF group was much higher than the non-AF group for heart failure (ARR: 0.4%, [95%CI: 0.0-0.7%], P = 0.057) and CVE (ARR: 1.6%, [95%CI: -0.1% to 3.3%], P = 0.071). No significant effect was noted on all-cause or cardiovascular mortality, stroke, or myocardial infarction.This study suggests that RAAS blockade offers protection against heart failure and cardiovascular events in high cardiovascular disease risk subjects with atrial fibrillation.
近期研究表明，房颤会显著增加心血管疾病高风险受试者出现不良临床结局的风险。应用肾素-血管紧张素-醛固酮系统阻滞剂预防房颤复发及房颤受试者的不良临床结局，在理论上是一个有吸引力的概念。然而，评估肾素-血管紧张素-醛固酮阻滞剂对心血管疾病高风险房颤受试者不良临床结局影响的临床试验结果仍不明确。对6项评估肾素-血管紧张素-醛固酮阻滞剂对房颤受试者疗效的随机对照试验进行了汇总研究。共有6项随机对照试验，纳入了总计53510例患者，随访1至5年。肾素-血管紧张素-醛固酮系统阻断治疗使心力衰竭发生率降低了14%（比值比：0.86，[95%置信区间：0.76 - 0.97]，P = 0.018），心血管事件发生率降低了17%（比值比：0.83，[95%置信区间：0.70 - 0.99]，P = 0.038）。房颤组心力衰竭（绝对风险降低率：1.4%，[95%置信区间：0.2 - 2.6%]，P = 0.018）和心血管事件（绝对风险降低率：3.5%，[95%置信区间：0.0 - 6.9%]，P = 0.045）的相应绝对风险下降幅度远高于非房颤组的心力衰竭（绝对风险降低率：0.4%，[95%置信区间：0.0 - 0.7%]，P = 0.057）和心血管事件（绝对风险降低率：1.6%，[95%置信区间：-0.1%至3.3%]，P = 0.071）。在全因死亡率、心血管死亡率、中风或心肌梗死方面未观察到显著影响。本研究表明，肾素-血管紧张素-醛固酮系统阻断可为心血管疾病高风险房颤受试者提供针对心力衰竭和心血管事件的保护作用。
